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April 24, 2019

Nursing Home Falls with Injury from 2013 – 2018: A Presentation for the MA Commission on Falls Prevention. April 24, 2019. Chiara S. Moore, MPH Epidemiologist Bureau of Health Care Safety and Quality. 1. Massachusetts Department of Public Health mass.gov/dph. Overview. Background

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April 24, 2019

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  1. Nursing Home Falls with Injury from 2013 – 2018: A Presentation for the MA Commission on Falls Prevention April 24, 2019 Chiara S. Moore, MPH Epidemiologist Bureau of Health Care Safety and Quality 1 Massachusetts Department of Public Health mass.gov/dph

  2. Overview • Background • Data Sources • Results • Nursing Home Population • Describing the Population that Experienced Falls with Injury in Nursing Homes from 2013 – 2018 • Describing the Falls with Injury that Occurred in Nursing Homes from 2013 – 2018 • Discussion • Questions Massachusetts Department of Public Health mass.gov/dph

  3. Background https://www.managedhealthcareconnect.com/article/6319 https://www.mass.gov/files/documents/2018/07/19/special-emphasis-older-adult-falls-jun-2018.pdf Nursing home residents are estimated to fall two to three more times as often as the community-dwelling individuals ≥60 years old1 It is estimated that nursing home residents make up about 18% of elder falls (age 65+) that result in death2 10-25% of falls among older residents in nursing homes result in a fracture, laceration, or need for hospital care1 MA nursing homes are required by regulation to report falls with injury to DPH Massachusetts Department of Public Health mass.gov/dph

  4. Data Sources Health Care Facility Reporting System • Pursuant to 105 CMR 150 nursing homes are required to report falls resulting in injury to the Department of Public Health (DPH) • Beginning in 2013 facilities transitioned from paper-based reporting to reporting falls with injury through the a secure, web-based application, Health Care Facility Reporting System (HCFRS) Minimum Dataset • To contextualize data, HCFRS falls with injury data was compared to the Minimum Dataset (MDS), a comprehensive assessment performed on each nursing home resident upon admission, after any significant clinical change, and quarterly thereafter Massachusetts Department of Public Health mass.gov/dph

  5. Introduction to the MA Nursing Home Population • There were, on average, 133,000 nursing home residents (long stay and short stay) per year from 2013 – 2018. • Most nursing home residents are between the ages of 70 and 89 • About 60% of NH residents are female • NH residents are predominantly White/ Caucasian Massachusetts Department of Public Health mass.gov/dph Data sources: Nursing home population – Minimum Data Set (CMS) extracted 03/29/2019.

  6. Introduction to the MA Nursing Home Population • There were, on average, of 133,000 nursing home residents (long stay and short stay) each year from 2013 – 2018. • Most nursing home residents are between the ages of 70 and 89 • About 60% of NH residents are female • NH residents are predominantly White/ Caucasian Massachusetts Department of Public Health mass.gov/dph Data sources: Nursing home population – Minimum Data Set (CMS) extracted 03/29/2019.

  7. Introduction to the MA Nursing Home Population • There were, on average, of 133,000 nursing home residents (long stay and short stay) each year from 2013 – 2018. • Most nursing home residents are between the ages of 70 and 89 • About 60% of NH residents are female • NH residents are predominantly White/ Caucasian Massachusetts Department of Public Health mass.gov/dph Data sources: Nursing home population – Minimum Data Set (CMS) extracted 03/29/2019.

  8. Introduction to the MA Nursing Home Population • There were, on average, of 133,000 nursing home residents (long stay and short stay) each year from 2013 – 2018. • Most nursing home residents are between the ages of 70 and 89 • About 60% of NH residents are female • NH residents are predominantly White/ Caucasian Massachusetts Department of Public Health mass.gov/dph Data sources: Nursing home population – Minimum Data Set (CMS) extracted 03/29/2019.

  9. Falls with Injury Reported Through HCFRS • From 2013 to 2018 there were 20,686 falls with injury reported in HCFRS from 431 nursing home facilities • 12,353 falls with fracture • 6,487 falls with laceration • 3,056 falls (other, includes hemorrhage and bruising) Massachusetts Department of Public Health mass.gov/dph

  10. Rate of Falls with Injury by Age Note: The data for rate of nursing home falls among residents 100+ has been suppressed due to small numbers. Data sources: Falls – Health Care Facility Reporting System (HCFRS) extracted 03/28/19; Nursing home population – Minimum Data Set (CMS) extracted 03/29/2019. Massachusetts Department of Public Health mass.gov/dph

  11. Rate of Falls with Injury by Gender Data sources: Falls – Health Care Facility Reporting System (HCFRS) extracted 03/28/19; Nursing home population – Minimum Data Set (CMS) extracted 03/29/19. Massachusetts Department of Public Health mass.gov/dph

  12. Rate of Falls with Injury by Race Note: The data for rate of nursing home falls among American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and Other or Missing residents has been suppressed due to small numbers. Data sources: Falls – Health Care Facility Reporting System (HCFRS) extracted 03/28/19; Nursing home population – Minimum Data Set (CMS) extracted 03/29/2019. Massachusetts Department of Public Health mass.gov/dph

  13. Rate of Falls with Injury by Ethnicity Data sources: Falls – Health Care Facility Reporting System (HCFRS) extracted 03/28/19; Nursing home population – Minimum Data Set (CMS) extracted 03/29/19. Massachusetts Department of Public Health mass.gov/dph

  14. How to Interpret Relative Risk and 95% Confidence Intervals Not significantly different than the reference group Significantly higher than the reference group * * * * Significantly lower than the reference group • The bar graphs represent the relative risk for different groups (columns). The grey bars represent the 95% confidence interval (CI). The 95% CI measures the probability that the true relative risk falls between the two parameters. All rates presented are relative. • If the CI bar crosses 1.0 (highlighted in red), then the relative risk is not statistically significantly different than the rate in the reference group. • If the CI bar is completely above or below 1.0, then the relative risk is statistically significantly different than the rate in the reference group. These are also indicated by an asterisk (*). Massachusetts Department of Public Health mass.gov/dph

  15. Relative Risk of Falls with Injury by Race by Year * * * * * * * * * * * * Note: The data for relative risk for among American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and Other or Missing residents been suppressed due to small numbers. Data sources: Falls – Health Care Facility Reporting System (HCFRS) extracted 03/28/19; Nursing home population – Minimum Data Set (CMS) extracted 03/29/2019. Massachusetts Department of Public Health mass.gov/dph

  16. Falls with Injury: Length of Stay Prior to Injury ≥100 Days <100 Days Note: Excluded reports with admit date prior to 1990 Massachusetts Department of Public Health mass.gov/dph Data sources: Falls – Health Care Facility Reporting System (HCFRS) extracted 03/28/19.

  17. Falls with Injury: Location Note: Excluded locations with <5 reports. Massachusetts Department of Public Health mass.gov/dph Data sources: Falls – Health Care Facility Reporting System (HCFRS) extracted 03/28/19.

  18. Falls with Injury: Resulting Harms Note: Excluded any harm types that were reported that had <5 reports in any given year. Massachusetts Department of Public Health mass.gov/dph Data sources: Falls – Health Care Facility Reporting System (HCFRS) extracted 03/28/19.

  19. Falls with Injury: Resulting Harms Massachusetts Department of Public Health mass.gov/dph Data sources: Falls – Health Care Facility Reporting System (HCFRS) extracted 03/28/19.

  20. Falls with Injury: Device Used Massachusetts Department of Public Health mass.gov/dph Data sources: Falls – Health Care Facility Reporting System (HCFRS) extracted 03/28/19.

  21. Discussion • Older residents, women, and Asian residents had higher rates of falls with injury • We observed that Black/ African American nursing home residents had lowest relative risk of falls with injury, compared to White residents from 2013 – 2018 • This could be due to underreporting • Can we use characteristics to target interventions and fall prevention activities in nursing homes? Massachusetts Department of Public Health mass.gov/dph

  22. Discussion • Over 50% of falls with injury occurred in a resident’s own room • Most reported falls resulted in fracture, laceration, or bruising • Most residents who experienced a fall were not using equipment • Those who were using an assistive device mostly used wheelchairs, walkers, or canes • Are there opportunities to intervene with additional/ different devices to encourage patient safety? Massachusetts Department of Public Health mass.gov/dph

  23. Discussion Are there any other analyses/ questions about nursing home falls that you would like to see? Next steps Link data to vital statistics (deaths) and MDS (additional patient information) Revise and continue analysis Incorporate feedback Develop falls report for release this year (2019) Massachusetts Department of Public Health mass.gov/dph

  24. Thank you! Please direct any questions to: Chiara S. Moore, MPH Epidemiologist Bureau of Health Care Safety and Quality Chiara.moore@state.ma.us

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